Doctor Name: | DR. JARED JON PIKUS |
NPI Number: | 1164650289 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO, |
License Number: | |
Business Practice Address: | 701 Lewiston Street Cottonwood, ID - 835220565 |
Business Phone Number: | 2089623267 |
Business Fax Number: | 2089622478 |
Mailing Address: | Po Box 565, COTTONWOOD |
State: | ID |
Postal Code: | 835220565 |
Phone Number: | 2089623267 |
Fax Number: | 2089622478 |
NPI Enumeration Date: | 06/26/2009 |
NPI Last Update Date: | 10/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |